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Pathological mechanisms of left main stent failure


European Bifurcation Club 2018 – EBC 2018 – Brussels, Belgium

LM PCI techniques and results

Pathological mechanisms of left main stent failure

Author: Renu Virmani, MD CVPATH Institute, Inc. Gaithersburg, MD, USA



  • Ostial portion of LMCA is rich in elastic fibers and SMCs which can lead to elastic recoil, whereas distal bifurcation is characterized by flow disturbance and procedural complexity
  • LM angle correlates with greater length of LM artery
  • Atherosclerotic plaque at bifurcation was predominantly seen in lateral wall (low shear) rather than flow divider (high shear)
  • Longer LM length is associated with greater luminal narrowing.
  • In bifurcation stenting, lateral wall is likely to have thicker neointima, whereas uncovered struts are significantly greater in flow divider regions than in lateral wall.
  • Causes of stent thrombosis in LMT are malapposition, protrusion of strut into aorta, medial tear, and strut crossing an ostial side branch
  • No differences in stent thrombosis were observed between provisional vs. two stent technique
  • Malapposition is mostly associated with stent failure in LMT stenting.
  • We have traded thrombosis for restenosis by using DES


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